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目的 观察用他克莫司 (FK5 0 6 )替换环孢素A(CsA)治疗肾移植术后耐激素性排斥反应的效果。方法 2 6例肾移植患者应用CsA后出现排斥反应 ,经用甲泼尼龙 (MP) 0 .5g/d× 3d冲击治疗效果不佳 ,改用FK5 0 6治疗 ,FK5 0 6的浓度维持在 8～ 12 μg/L左右 ,临床症状减轻 ,免疫及生化指标逐渐好转 ,为治疗有效。治疗无效者主要改用单克隆抗CD3抗体 (OKT3)治疗。结果 本组 2 6例耐激素性排斥经改用FK5 0 6后 ,2 3例分别在 8～ 15d逆转 ,肾功能恢复正常 ,治愈率 88.46 % (2 3/2 6 )。 3例治疗效果不佳 ,使用血浆置换治疗和OKT35mg/d× 5d后排斥逆转。 2 6例肾功能全部恢复正常 ,但有 3例出现高血糖。结论 FK5 0 6治疗耐激素性排斥反应效果好 ,副作用小。治疗时应掌握诊断标准 ,注意监测血糖及生化指标。对于PRA高于 30 %的患者行血浆置换治疗 ,加用OKT3冲击治疗 ,可取得满意的效果。经上述治疗效果不佳者应及早切除移植肾 ,以保证患者的生命安全
Objective To observe the effect of replacing cyclosporin A (CsA) with tacrolimus (FK506) in the treatment of steroid rejection after renal transplantation. Methods Twenty-six renal transplant recipients developed rejection after CsA administration. The treatment with methylprednisolone (MP) 0.5g / d × 3d was ineffective and treated with FK506. The concentration of FK506 was maintained at 8 ~ 12 μg / L or so, reduce clinical symptoms, immune and biochemical indicators gradually improved for the treatment of effective. The treatment of ineffective use of monoclonal anti-CD3 antibody (OKT3) treatment. Results After 26 cases of steroid rejection were switched to FK5 0 6, 23 cases were reversed from 8 to 15 days, and their renal function returned to normal. The cure rate was 88.46% (2 3/2 6). 3 cases of poor treatment, the use of plasma exchange therapy and OKT35mg / d × 5d after rejection repel. 26 cases of renal function returned to normal, but 3 cases of hyperglycemia. Conclusion FK5 0 6 treatment of hormone-refractory rejection with good side effects. Treatment should grasp the diagnostic criteria, pay attention to monitoring blood glucose and biochemical indicators. For PRA higher than 30% of patients undergoing plasma exchange therapy, plus OKT3 impact treatment, can achieve satisfactory results. After the above treatment ineffective patients should be removed as soon as possible to ensure the patient’s life safety